Cannabidiol prevents chemotherapy-induced neuropathic pain by modulating spinal TLR4 via endocannabinoid system activation

J Pharm Pharmacol. 2023 Apr 17;75(5):655-665. doi: 10.1093/jpp/rgad023.


Objectives: This study aimed to investigate the effect of cannabidiol (CBD) on type 4 Toll-like receptors (TLR4), glial cells and pro-inflammatory cytokines during the neuropathic pain induced by the chemotherapy agent paclitaxel (PTX), as well as the involvement of the endocannabinoid system in this process.

Methods: Male C57BL6 mice were subjected to PTX-induced neuropathic pain. To evaluate the involvement of the TLR4, glial cells and cannabinoid CB2 receptor, specific inhibitors or antagonists were intrathecally administered. The western blotting and immunofluorescence assay was performed to evaluate the spinal expression of TLR4, microglia, astrocytes and cannabinoid CB2 receptor. The levels of spinal pro-inflammatory cytokines and endocannabinoids were determined by enzyme-linked immunosorbent assay and liquid chromatography-mass spectrometry analysis, respectively.

Key findings: CBD prevented PTX-induced neuropathic pain, and the cannabinoid CB2 receptor antagonist AM630 reversed this effect. In addition, CBD treatment inhibited the spinal expression of TLR4 and Iba1 in mice with neuropathic pain. CBD also increased spinal levels of endocannabinoids anandamide and 2-arachidonoylglycerol, and reduced levels of cytokines in mice with neuropathic pain.

Conclusions: CBD was efficient in preventing PTX-induced neuropathic pain, and this effect may involve inhibition of the TLR4 on microglia spinal with activation of the endocannabinoid system.

Keywords: cannabidiol; glial cells; neuropathic pain; pro-inflammatory cytokines.

MeSH terms

  • Animals
  • Antineoplastic Agents* / therapeutic use
  • Cannabidiol* / pharmacology
  • Cannabidiol* / therapeutic use
  • Cannabinoids*
  • Cytokines
  • Endocannabinoids / metabolism
  • Male
  • Mice
  • Mice, Inbred C57BL
  • Neuralgia* / chemically induced
  • Neuralgia* / drug therapy
  • Neuralgia* / prevention & control
  • Paclitaxel / therapeutic use
  • Receptor, Cannabinoid, CB2 / therapeutic use
  • Toll-Like Receptor 4


  • Endocannabinoids
  • Cannabidiol
  • Toll-Like Receptor 4
  • Receptor, Cannabinoid, CB2
  • Cannabinoids
  • Paclitaxel
  • Cytokines
  • Antineoplastic Agents
  • Tlr4 protein, mouse